Femoral Component Incarceration at the Distal Slot

Femoral components with distal coronal slots were introduced to decrease the stiffness mismatch of the femoral diaphysis and stem. We present 2 cases in which the stem of an S-ROM (DePuy, Warsaw, Ind) endoprosthesis was incarcerated in the diaphysis of the femur by bone growth through the distal slot. In both cases, this finding was discovered intraoperatively, following multiple unsuccessful attempts at stem extraction. We recommend performing a trans femoral cortical window at the distal slot, which provides adequate visualization of the stem and allows for resection of the anterior tine and osseous bar. Early recognition of this potential pitfall may decrease the risk for iatrogenic femur fracture, prolonged operative time, extended anesthetic exposure, and greater blood loss.